Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(1):90-94 | DOI: 10.5507/bp.2018.044

Therapeutic plasma exchange in secondary prevention of acute pancreatitis in pregnant patient with familial hyperchylomicronemia

Renata Michalova Jr.^a, Anna Mankova^a, Matej Vnucak^a, Stanislava Mikulova^a, Frantisek Nehaj^a, Katarina Raslova^c, Ivana Dedinska^b, Alena Jezikova^a, Pavel Makovicky^a, Peter Galajda^a, Marian Mokan^a

^a Clinic of Internal Medicine I, Martin University Hospital and Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic

^b Surgery Clinic and Transplant Center, Martin University Hospital and Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic

^c Coordination Centre for Familial Hyperlipidemias, Slovak Medical University, Bratislava, Slovak Republic

Introduction: Hormone changes during pregnancy lead to increased plasma lipid levels. When there is added disorder of lipid metabolism, this otherwise physiological change can cause extremely high triglyceride levels with potentionally life-threatening complications, such as non-biliary acute pancreatitis.

Materials and Methods: We present a case report of a 27-year-old pregnant woman with familial hyperchylomicronemia and a history of 7 hypertriglyceridemia-induced acute pancreatitis attacks. Three attacks occured during her first pregnancy with the last one leading to its termination at 33 weeks owing to the death of the fetus. During her second pregnancy, standard treatment was not able to lower the triglyceride levels sufficiently and she suffered another acute pancreatitis attack. Therapeutic plasma exchange was therefore chosen as the treatment method.

Results and Conclusion: Plasma exchange was succesful in the secondary prevention of acute pancreatitis attack and she delivered a healthy baby at 36 weeks of gestation. Treatment was very well tolerated by the mother and the fetus and this supports the use of apheresis as a safe and efficient method in tackling gestational hypertriglyceridemia.

Keywords: acute pancreatitis, hypertriglyceridemia, pregnancy, therapeutic plasma exchange

Received: March 21, 2018; Accepted: August 6, 2018; Prepublished online: September 7, 2018; Published: February 18, 2019  Show citation